dilatation of ascending aorta

I'm 52, and had an MRI one year ago to detect breast cancer. I was diagnosed with BC - but the radiology report also noted: "mild aneurysmal dilatation of the ascending aorta, measuring up to 42mm. The aortic arch and descending thoracic aorta have a normal caliber."
I was told to eventually have it checked out - now, a year later I had a repeat MRI after a year of BC treatment - (no sign of cancer) with the same aorta outcome - however this time they measured it at 40mm.
I was told to see a Fam. Prac. physician for a referal to a vascular surgeon. I will do that - but I wonder, what is the best method for diagnosing this condition (for a breast cancer MRI, you lay on your stomach). Also, is this enough to be alarmed about? What about the location...are some locations worse than others? At what point is surgery recommended? And, my oncologist said 'this won't get better' - I understand that, but why the change from 42mm to 40mm?
I don't smoke - I'm 5'6" and 130 lbs - and otherwise in excellent shape.
Thank you for this service.

This is one of the most common questions we see here in the forum. There are a lot of old post that might be helpful to search. We see mild dilation of the aorta fairly frequently in people as they get older. The most common cause is generally hypertension. Other diseases such as aortic stenosis and Marfans can also be associated with it. The variability in your measurments is not out of the ordinary and unless the aneurysm was getting markedly larger over time, of little concern. Genrally a CT or MRI is adequate and the best method for following the aorta. There is some variability in when to operate, if your aneurysm was rapidly expanding over a short period (meaning 6 mos to a year), it carried symptoms gets above 5 cm unless you have Marfans or a bicuspid valve. Continue to lead a fit life with good control of all of your cardiovascular risk factors.

typically a catsacan or mri most accurate measurement
unfortuanlty it will only get worse-what people will not be able to answer is how quickly becasue you may not have any other reports to compare to.
many places aroun nation recommend surgery at 50mm
maybe earlier if you have marfans.
this could take many, many years for you to get their
i would think the arch is the worst spot for an anerysm
nothing to do with health, you were most likely born with a weakness in tissue, marfans, bicusoud valve etc.
stay on it.

Nick, my husband gets checked for this every year with one of the very best thoracic surgeons in the country. It is with a CT scan done at HIS hospital and read by him and experienced radiolgists. They compare previous films with recent films andlook for changes. Good Luck

I was told to see a Fam. Prac. physician for a referal to a vascular surgeon.
>>We don't know if your 4.2/4.0 measurement refers to the ascending aorta above the root, or if it refers to the aortic root itself. If it is the root itself, it's probably not worth worrying about too much yet - after all, your measurement has been stable for a year. However, if it's some part other than the root, then the root itself may be larger than 4.2/4.0. Main point: you should go ahead and visit the surgeon, since 4.2/4.0 is a bit large for someone as small as you. By comparison, I am 26, 6'1", 190+ lbs, and at around 3.8 last time I was checked.

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I will do that - but I wonder, what is the best method for diagnosing this condition (for a breast cancer MRI, you lay on your stomach).
>>Previous poster was right, MRI and CT scan are best. More important is to repeat the same test over time, since there can be variation between different types of tests. IDEALLY, you'd have the same type of test done by the same tech at the same place on the same machine once a year, or once every 6 mos, etc. I do not think that position matters, but I could be wrong.
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Also, is this enough to be alarmed about?
>>See above. Probably not ALARMED, but something to watch.
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What about the location...are some locations worse than others?
>>I believe previous poster is right, arch is one of the worse places to have it. But yours is in the ascending aorta - surgery wise, I think this is much easier to fix if it ever came to that. Though the condition is serious and warrants monitoring, it is still pretty common.
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At what point is surgery recommended?
>>Depends. Like the previous poster said, usually between 5.0 and 5.5, depending on your body size and other factors. It may never get that big. A surgeon would know best... if you have Marfan or another connective tissue problem, 4.5-5.0 is probably better.
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And, my oncologist said 'this won't get better' - I understand that, but why the change from 42mm to 40mm?
>>There is always variation between tests. A difference between 4.2 and 4.0 is not huge; it's standard error for a CT scan. You can basically walk away knowing that your ascending aorta is mildly dilated just above 4.0. Also, your oncologist said it won't get better - well, it won't necessarily get worse, either. I do not think surgery is indicated at this point, but the doc on this forum would know better. Certainly a consultation with a surgeon should be done.
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I don't smoke - I'm 5'6" and 130 lbs - and otherwise in excellent shape.
>>Good! Smoking is really bad for not just the heart, but the aorta as well.

You're doing all the right stuff. Your doctors will determine, based on your specific risk factors, what your surgical threshold for dilitation is. You'll need regular monitoring, they're looking for any increase in dilitation, as well as aortic valve issues.

Definitive test for this is CT with contrast. Standard MRI is not specific - you need an MRA for that, where they inject you with gadolinium, which increases MRI contrast for your blood system. Other tests frequently used are standad echocardiogram and trans-esophogeal ecocardiogram (TEE).

Don't freak out reading aortic dissection articles on the internet. You're lucky - they found your condition early and you're getting montiored. If you eventually need surgery, go to a top-notch place like Cleveland Clinic, you want a specialist who has done hundreds of these procedures.

I had mine done 2 1/2 years ago, I do everything I did before the surgery, except I avoid any lifting that would involve straining. I ride my bike 150 miles a week with no problems related to my surgery. I take a beta blocker to the maximum rate of change of arterial pressure (dP/dt), it's annoying, but you get used to it.

Do you have high blood pressure? My husband has a mildly dilated aorta, and his is suspected to be caused by blood pressure, though that's only one of many things that can do it. Your measure could be just reader variability, as even the same interpreter is likely to get a hair of variation from one to the next test. My husband measures a touch different on each echo, but always about the same. A dilated aorta won't fix itself, so definitely don't let that go without seeing someone for it.

I'm really glad to hear that there's no sign of the cancer now, that's awesome! Best wishes for continued good health.

1. One should not see a vascular surgeon for an ascending aortic aneurysm. They treat descending aortic aneurysms, but not ascending. A cardiothoracic surgeon is what you need. My (former) cardiologist (who should have known better) sent me first to a vascular surgeon--the facility was kind enough to rustle up a CT surgeon.

2. Pbanders is correct that a TTE (transthoracic or "regular" echocardiogram) is often used to follow an aortic aneurysm. However, it is not an appropriate test as it does not show the entire ascending aorta.

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